Register

Select Your Program(Required)

April Clinic

Summer Session

Note: You will specify which session dates you want later in this form.

Players Name(Required)

First Last

Your Email(Required)

Additional Email (Player or Guardians)

List as many additional emails as needed here

Players Date of Birth(Required)

Players Address(Required)

Street Address City State ZIP Code

Player's Schools(Required)

What middle/high school will you be attending in the fall of 2024?(Required)

Plays on(Required)

Grade Level(Required)

Grade entering in the Fall of 2024(Required)

Are you a goalkeeper?

Check if you are

I am a goalkeeper

Guardian(s) emergency contact info(Required)

Add as many guardians as you need here

Name

Cell Number

Family Physician(Required)

Physician Phone(Required)

Medical Insurance Company(Required)

Policy Number(Required)

Group Number(Required)

Physical conditions(Required)

Physical conditions the staff should be aware of: allergic reactions (drugs/medicine, food, environmental/plant) , reoccurring illness, disabilities, chronic illness, etc. **Please put none if this does not apply**

Concussion Awareness(Required)

Please read the following information regarding concussion awareness

A check here acts as acknowledgement of reading the above information regarding concussion awareness and steps our clinic will take if a concussion is suspected

Medical Treatment(Required)

In the event an illness or injury requires more extensive treatment, I understand every reasonable attempt will be made to contact the family and/or emergency contacts listed in this form. However, in the event I cannot be reached, I consent for directors/staff of Prep Soccer Academy to authorize any necessary treatment. I understand that family medical insurance must be used. Prep Soccer Academy does not provide medical insurance for players.

I agree to the Medical Treatment release

Additional Information/notes we should know or be aware of.

Release of Liability(Required)

Release of Liability: I/We, the undersigned, hereby certify that I (we) am (are) the parent or legal guardian of the player. I hereby give permission for the staff of the PREP SOCCER ACADEMY, L.L.C. to seek (during the period of the clinic) appropriate medical attention and for the player to receive medical attention and treatment, except for that covered by the clinic’s excess medical coverage policy. I/We, the undersigned, hereby acknowledge and understand that PREP SOCCER ACADEMY, L.L.C. are privately run sports clinics and are not operated by or through the Town of Brookline or City of Newton, but rather is under the sole sponsorship, control and supervision of the clinic administrator, PREP SOCCER ACADEMY, L.L.C.. I/We, the undersigned, for ourselves, our heirs, executors and administrator, waive, release and forever discharge the Town of Brookline and PREP SOCCER ACADEMY, L.L.C. staff, officers, agents, employees, representatives, successors and assign from any and all liability claims, demands, actions and causes of actions whatsoever arising out of or related to any loss, personal injury or property damage that may be sustained or occur during participation in clinic activities or while at the clinic. I certify that my child has never had to register under Article 7, Sex Offender Registry. I have read and understand the Release of Liability

A check here acts as acknowledgement of reading and signing this Release of Liability

MIAA Rules(Required)

I understand that this Prep Soccer Academy clinic and the high school tryout process ARE SEPARATE and IN NO MANNER RELATED. As a result, attending this clinic does not impact the tryout process in any way. All MIAA rules and regulations will be adhered to.

A check here acts as acknowledgement of reading and accepting this Statement and understand this policy

Payment Method(Required)

Select a payment Method

Venmo

Bring check on Day #1

Total

Please send payment using Venmo to: @PrepSoccerAcademy

Please make you check payable to Prep Soccer Academy and include “player/s first and last name, location” in the note section. Bring to first session.

Phone

This field is for validation purposes and should be left unchanged.

Prepare for Results

April Clinic

Summer Sessions

Prep Soccer Registration

Tuition

When

Where